The Angry Pharmacist Socalized Health Plan Solution

Here is my outline as to what could be the perfect socalized will-fail-less government subsidized medicine plan. Since obviously this is going to be passed riding on the coattails of the H1N1 fear and panic machine, I could at least throw in my $0.02 as to how this is to be laid out.

Now before you read this, remember years past when WalMart came into town? How they used their huge might to pretty much crush any competition in the area with “low low prices” all while shitting on their employees and being an all-around shitty store with poor service. Now considering this government plan has the financial backing of every taxpaying man and woman in the nation (regardless if they want to or not); think of Walmart as your cushy retirement insurance plan goes bankrupt and you’re forced to enroll into a government ran plan.

The Angry Pharmacist Socialized Health Plan Solution

By: The Angry Pharmacist

http://www.theangrypharmacist.com

Here are some nice and easy (and unrealistic) points that this new government funded (with freshly printed money/stolen from the working class) health plan should have:

No trade name drugs are covered. No exceptions. Prilosec/Protonix doesn’t work for you? Tough shit. Cough with ARB? Too bad. None of the trade name medications would be covered. The government needs to eat its own dogfood (or practice what it preaches) and only does business with companies that drive down the cost of medication (ie: generic companies). That expensive chemo drug not covered? Then let the government use taxpayer dollars to buy out Amgen so they can give it out for free (why not, everyone else got bailed out).

The plan is voluntary. If you wish to be a part of Obamacare, then you get the premiums deducted out of your gross-pay. If you wish to have private health care, then you won’t be dinged a dime for Obamacare. I’m not paying for all of your PacifiCare and Blue Cross plans (and your insurance premium dollars dont pay for my private insurance) so why should I have to pay for someones Obamacare? The chances of this happening are as likely as you buying the nice bridge I have for sale.

You get 4 doctors visits a year with no/low copay (say, $10). Every doctors visit after that has a $25-50 copay. Yeah, it sucks for the people with chronic conditions like diabetes and stuff, but its better than nothing. Don’t get the unlimited text messaging plan and you can afford your doctors visits. Don’t order a large pizza and you can afford another doctors visit. Wait, actually becoming an active part in my health? What is this witchcraft you speak of!

You get 1 $0 copay ER room a year. Every ER visit after that is $100 minimum. I’d like to see this figure raised to $250 or higher since ER is for……. EMERGENCIES! You know why the ER rooms are so packed? People view them as “Free”.

Since all Rx’s will be billed to the government, if you are on a maintenance medication and you are non-compliant, guess what, your premiums just went up unless YOU (not your doctor, not your pharmacy) can submit documentation showing that you were taken off of that drug, or switched to another one due to intolerance. Whats the point of the government dumping all this cash into your doctors visits and medications if YOU are TOO LAZY to do anything about YOUR CONDITION. Not taking your medication is just pissing away money. No matter how many times I bitch, your doctor bitches if you don’t want to take your medicine then you can get dinged in the pocketbook. True this can be thwarted by people just picking up their regular drugs and not taking them, but it might make a few people think twice before asking for medication they have no intention of taking. Cue the “Waah, we don’t want the government poking its nose into our lives” as they happily promote Obamacare. Wait, are you confused?

If your doctor kept up to the standard of care, then unless his peers can show an act of negligence, you cannot sue him/her for 1.4 zillion dollars in a huge malpractice suit. Lets face it, without your doctors care, you would have died a long time ago. We don’t need your doctor running up the bill with 400 lab tests every damn office visit out of fear of getting sued if he/she happened to miss something weird.

Now on the surface, this plan looks pretty damn shitty. However we have a fundamental problem in this country where we want privatized health-care at socialized prices (ie: Free). Not going to happen, actually it can’t happen! Look at MediCare and how broke it’s becoming! No seniors bitch about Medicare (doughnut hole), because they are so (doughnut hole) happy about the coverage (doughnut hole) that it provides (doughnut hole). Did I mention that the government had to implement the doughnut hole to keep the Medicare system from going completely broke? Did I also mention that we just slapped Rx drug benefits on top of an already stressed system like an idiot taking a 4th mortgage out on his house to buy a boat then wondering why he can’t make the payments. Should I just ignore the point that before Medicare part D came out, seniors on MediCare were paying cash-money for ALL of their medications and were doing just fine on all generics? It wasn’t until the government decided to “feel sorry for them” and slap on a part-D plan that they became greedy and wanted trade name shit (all for no copays).

If health plans were cars, this would be the basement model with no A/C, manual transmission, manual windows/door locks, and it pretty much just gets you where you need to go. This would be the ideal solution. It gives people the basic care they need, and to be honest if they wished for a plan with more bells and whistles then some most-costly private plans could do them well.

Oh, but wait, we all want our cake and eat it too. Mark my words, this plan will give people an inch when they want a mile, and short of the entire collapse of the healthcare system, the public will just want MORE for LESS.

48 thoughts on “The Angry Pharmacist Socalized Health Plan Solution”

It addresses most of the major cost problems in our health care system while still allowing private insurances to have a place and a purpose.

In fact… Given the way our country’s economy is set up. I think this might possibly be the best plan I’ve heard. Let’s face it. We absolutely have to reduce wasteful spending. No more emergency room trips for the common cold. No more prescribing of “me too” brand names when there are perfectly effective generic alternatives.

As you said everyone wants their cake and to eat it too. They want to do whatever the hell they want to do and not pay anything. Sorry… health care does not work like that. I promise that outcomes will not become more negative if somsone is stuck taking omeprazole instead of Kapidex.

You want free health care? You submit to certain rules… No Exceptions.

Wow Mike, just when I thought you were completely insane with this healthcare stuff you retract that opinion a bit. I wrote a similar essay once about what we should do about healthcare, but I extended the idea to ALL social programs. This would mean things like instead of giving food stamps, give 50 lb bags of brown rice and beans. But you have to understand, this is not he plan that Americans are voting for, it is the one where they get everything they want and pay nothing.
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The public is so incredibly stupid about the “need” for insurance. I’ve said it before and I’ll say it again. Health insurance, by it’s very nature, can NEVER drive down the cost to the insured for what it covers. It can only do the opposite. When will people wake up and realize that health insurance is not at all a necessary part of society

If there were not health insurance (public or private), we would see an end to so many things bastardizing the health care industry……….1)expensive trade name drugs, 2) $20,000 appendectomies, 3) no more second loans required for a relative sick with cancer

People simply don’t understand that the only reason health care costs so much is b/c of insurance (public and private)……….if insurance did not exist, people would “shop around” for the right prices of their health care

And another thing, instead of constantly funding programs like medicaid, medicare part D, and SS which are totally going broke, why don’t we use that tax money (if it has to be used) for the research and development of cures/treatments for uncurable diseases, like cancer, and give this responsibility to a NON-PROFIT organization

With higher ER bills and less tax revenue going to the government from written-off unpaid medical bills, you pay for peoples health care anyway. We can do it now with the inefficient, expensive way that still doesnt cover everyone or we can do it the cheaper, efficient way.

So, I’m in favor of national health care, but I will say that the above plan (apart from point #1, anyway) is about what I want. As you said, basic-level (not premium) health care for everyone. Those that want premium care have to look outside of the national health plan. I think the co-pays (ER and doctor) are an especially good way to make doctor’s visits very affordable, yet above the bar of “what the hell, it’s free”.

As for the “voluntary” – I think that everyone should have to have insurance. Those that want a private plan can pay for that instead of national health care. For everyone else, it’s a tax automatically deducted from the paycheck.

Just because some of us want some sort of national health care plan doesn’t mean that we think everyone should get a Ferrari (to use your car analogy). I mean, ideally, yes — us bleeding-heart liberals would like everyone to have all the health care they need in an ideal world. But it’s not an ideal world, so the base model is what we can do (and all I ask for).

Unfortunately, unless you’re young and perfectly healthy, it’s difficult to get affordable insurance outside of the workplace. It’s also much easier for non-workplace insurers to drop customers unceremoniously.

It seems to me to be an odd thing to have healthcare and one’s job tied together. It probably prevents a lot of individual entrepreneurship because those with any sort of health condition need healthcare that they won’t be able to get at a reasonable price as a small business (depending on the state).

In fact, a national plan may help in other ways, because my bet is that right now there are people with medical conditions that are severe enough that they are not able to work at a job that provides health insurance. They might be able to work at a lower-intensity job, but need to limit their work to not lose Medicaid. So you may have fewer people on welfare by allowing them to buy reasonably-priced basic medical insurance through the government because they will now be able to work more at jobs that normally do not provide insurance. I don’t know, but it’d be interesting to look at whether or not that would be the case.

Key selling points:
voluntary and affordable option for those with pre-existing conditions,
not tied to employment at a particular work-place,
covers generic drugs as an efficient option (as opposed to tie-in backroom deals with brand name companies, or questionable non-FDA approved therapies)
provides incentive for buy-in for those needing basic coverage,
easily accessed by those with treatable and chronic conditions.

I’m assuming you meant “No trade name drugs are covered. No exceptions. Prilosec/Protonix doesn’t work for you? Tough shit. Cough with ACE (not ARB)?” Either way, it doesn’t make a differece as there will be a generic ARB (losartan) before any of this gets implemented anyway.

Don’t spam me, but I do feel strongly that everyone needs to participate, though private insurance will work as well as the public option. The problem is that we currently have too many people who don’t contribute to the system at all, then expect ALL Services to be available at their beck and call when they get sick. And, oh yeah..when the bill goes over $100K, they file bankruptcy and you and I eat it in the form of higher premiums.

Its the government that ties insurance to employment. Employers get tax credits for providing us access to insurance.Get rid of the subsidy and let individuals get tax credits.Then you wont have to stay at a miserable job just for the insurance. There are also many laws prohibiting purchasing insurance across state lines. That limits choices for myself and the employer.Can you imagine auto insurance legislated this way?

Remember about 10-20 years ago, when insurance companies were requireing mothers to leave the hosp. with their newborns after the first wet diaper? After a few infant/mother deaths, a state (Penn. first?) regulated the length of the stay after birth. Other states followed. I wonder how laws like this will be affected by purchasing insurance across state lines? Will we revert to one federal code? (insurance has one of the biggest lobbies out there) or, with the state with the least regulation have all the insurance co.? (like off-shore banking?) hmmm–just a thought

I stumbled across your website today and I am sitting here laughing my butt off. Thanks for being angry. Thanks for being creative. Thanks for having ideas on how to run a socialized health plan. I thought your suggestion about making people pay for brand name drugs was interesting. If people had to pay for brand-name drugs, and they weren’t subsidized, the prices would fall quickly. It’s a matter of supply and demand. As a pharmacist working in drug advertising and marketing, I know first-hand that most brand-name drugs are only marginally better than placebo.
Anyway, if you have a moment check out my blog at http://www.rxbalance.org – its a critical look at how drugs are marketed.

The healthcare thing doesn’t bother me as much as the idea that big brother is about to take over yet another industry. The power just keeps on shifting more and more. Oh, and they are doing this with a debt so large that every U.S. citizen owe’s aproximately 300,000 $’s. I’m sorry, but I can’t help but place my face into my palm.

I am all for healthcare reform. I am not for this crap the President is trying to force feed us. I lived for 2 years with back pain, every time my doctor tried to order an MRI the insurance threw a fit and refused to pay. They wanted physical therapy, chiropractor visits, and even occupational therapy so i wouldn’t hurt after work. After 2 years of playing their game, my company went with a new insurance company I called the doc he ordered an MRI and boom they payed for it the first time. So tell me why private insurance companies are good?? Anytime someone needs a test, I mean really needs a test, they will balk at it and have to jump through hoops. Yesterday at work had a 6 year old child with a confirmed case of swine flu, caught within 24 hours of signs, doctor ordered Tamiflu, well insurance required a prior auth, parents are on limited income and really can’t afford the $88, so I gave it to them and they will come back in when the prior auth goes through in 3 days.

You can’t charge someone a copay after the fact, you will have to make them prepay the ER or doctor office copay before they get seen, or you will rarely collect the copay. Why spend $500 on legal fees to collect a $10 copay? For this to work, major changes in doctor liability will have to be created.

So, what if someone goes to the ER, is really having a heart attack, but doesn’t have a credit card, has no bank account, and does not have the cash to prepay the copay? Someone be gettin’ sued.

As far as copays go, generally you do have to pay the copay before the doctor will see you. No problems there, no copay no appointment. For the ER, Angry states that everyone should be getting one visit to the ER at no cost per year. This seems reasonable. If someone does have two emergencies per year, then they would be billed for the copay. At least that’s how any health insurance that I have had worked. Most people will pay it, 1) if you are using your insurance the hospital has your real name and SS# therefore they can send it to collections and ding your credit, 2) Most people pay their bills, I know we hear a ton about those who skip out on ER bills, but most people with insurance pay the copays, 3) Even if the person refuses to pay the ER copay then the hospital is still reimbursed for most of the cost through the insurance. A hospital would rather write off the 250$ (or however much) copay than the whole bill.

I wonder how similar to VA benifits this sounds like? A few years of service, that you pay into while you work, in one of our “freedom-preserving” military outfits; and (barring some horrible body disfiguring explosion or boating accident) you can go to the doctor when you need to, as many times as they can see you. They have “ONE” formulary, just one. If the medication the doctor writes for(not the one you want) is not on said formulary, you bitch at the doctor for 2-3 months while you take one of the many generics available. and once you have “proven” yourself worthy of something non-formulary your condition is reviewed on a case by case basis and if its approved; non-formulary at your door step. and guess what else its free or very low cost. 3million lab test no problem, an MRI in another state cause your clinic doesn’t have the proper machinery; have 2 just get to this place on that street and its all yours. and you can claim your travel expenses once they hit a certain amount on your taxes. One 90 day rx with 3 refills on maintenence meds and mandatory f/u’s (follow-ups) for new scripts. Why do you think there are so many kick ass old guys with wrinkled tattoos from WWII. Because they understand the old saying…you get what you pay for. but you know people wont even throw stones at this plan because it associates our democratically ran military with socialist views and we cant have TOO much red with our white and blue. Or is it pink, i dont remember those days too well i was like 7 or something during the cold war.

“In fact, a national plan may help in other ways, because my bet is that right now there are people with medical conditions that are severe enough that they are not able to work at a job that provides health insurance. ”

Don’t be fooled…the people who really need healthcare such as the people with disabilities or in poverty already are provided healthcare. It is the middle class people who can afford healthcare but they feel like it should be given to us instead. I know people who are too cheap to pay for health insurance because they think they are young and healthy…yet as soon as they need it they start bitching about how the government should take care of them and how health professionals are greedy!

Yes, but if the people that are poor and have disabilities use the federal coverage they can get for free, and get better enough to work at a modest job, but that job doesn’t provide health insurance… Well, then they just got well enough to stop getting healthcare. Which means that they will no longer be well enough to work, etc.

With a national health care plan, they can get better enough to work at some job or another, and keep that job because it won’t jeopardize their health care to take it.

What the general public does not understand..is..when the government gets involved in healthcare( or takes it over….because they want total control)…The gov. will then start making tweeks to salaries for medical personel, licensing, procedures …and ultimitally ration treatment…duh
They will still be loyal to the drug companies, and their GE friends and the other big players. The medical profession will soon be a labor type job….not a profession….
I had a baby in a German hospital 23 years ago…it was hell ( no Doctor,(midwife instead), the same people who took care of the newborns, were also mopping the floors and cleaning the bathrooms at night, My newborns umbilical cord got infected….she was feverish, and sick…I actually had to take her and leave AMA…(againsy medical advice)

A lot of eople will get out of the profession, because the reasons they got in it to begin with…will not be possible. Good luck everyone

We Need to start a “Draft The Angry Pharmacist for President” campaign, if this country actually survives until the next election.

I had a visit today from our number one patient with the most well developed sense of entitlement I have ever seen, or can even imagine.
So, Basic Medical Care Plan (BMCP) sounds great by me. Capping a few trial lawyers, er, their fees actually makes total sense too.

The important thing to remember about this plan is that it needs to be state by state. The Feds have absolutely NO RIGHT under the constitution to impose any sort of national health plan on the citizens of the USA.

Before anything reasonable or rational like this stands the slightest chance we need to run a super powered electoral bowel prep/roter-rooter through the entire city of Washington, DC. There are too many folks there attached permanently to the Federal Milch Sow. Starting with congress. Time to clean them all out.

I would also add, smokers, drunks, and mandatory drug tests to obtain coverage. I’m someone that that truly believes in patient autonomy. If you want to put harmful things into your body, thats your business, but when your body breaks down, you made your bed, you lie in it. You want us to help take care of your body, you take care of it yourself first. If I could force them to do their daily exercises and be able to test for the amount of fast food they eat to, I’d make that contingent also

How about insurance companies (public or private) start offering a health plan for healthy people. If an employer has the balls to choose this health plan, more power to them… Most employees probably wouldn’t like it (cause most employees are probably fat/lazy/out of shape/etc), but if an insurance company offered this and an employer chose this, I’d love it. Here’s the basics.

Physical exams for all employees upon entry into the plan. Lower copays/premiums for healthy people. Higher copays for fatsos, smokers, high cholesterol, high BP, DM, etc… You want to lower your copay/premium?? Get your fatass to the gym. Stop smoking. Lower your Cholesterol/BP. BMI of 37??? Too bad, your SOL. BAM!-Ultra high copay for your fatass…. Silver lining? You bet! Once you lose all that blubber, your copay/premiums go down upon re-examination! Sweet deal, huh? BMI of 19 with a 5% body fat, good cholesterol, good BP, non-smoker?? NICE, you just earned yourself a kick ass low low premium, waaaaay less than that fatass smoker working next to you. Happen to be a smokin’ hot chick with huge cans?? Bonus! We’ll waive all momogram copays. (OK, so that last one is a little out there, but what the hell).

Anyway, you get the idea. You are fat/smoke/unhealthy = you pay (much) more according to you risk. You are thin/non-smoker/healthy = you pay less. If you don’t want to choose to be part of this plan, then thats fine. Your premiums will be about as high as the fattest of the fat, with zero opportunity to reduce your premium (via a healthy lifestyle) until next year’s re-enrollment timeperiod.

BTW, gym memberships, access to dieticians, and weight management meal plans all available for free or nearly free. You want incentive to get America’s fatass off the couch? Well now you got it. Hit ’em where it counts, right in the pocketbook. We’ll give you one year to lose that extra 215 lbs. Good luck, here’s some celery.

Even if it actually didn’t save the company or insurance company any money, at least its an incentive to get people off the couch and more in control of their own healthcare. (LOL, I know those last 5 words were funny!!!!)

I have defended Bush on almost every aspect of his administration, but privatizing Part D was a big mistake. The gov subsidized all of the PBM’s to help them set up a program to completely fuck our country. I was shown a payment report for one of my previous patients, who is now going to mail order. AARP mail order company charged $149 for 90 omeprazole, $48 for 90 Amlodipine 10 and $365 for 90 Lipitor 20. I compaired it to what they paid the pharmacy $47, $29, and $350 respectively. Over-charges like these drive patients into the donut hole at record paces. Medco is now making a serious move to eliminate all independent pharmacies by having triple copays at independent pharmacies, trying to force patients to go to “their” mail order pharmacy in the guise of saving money. Again the employeer is paying 25% more for theie prescriptions. How long can this shit keep going on. Is everyone in Washington that afraid of the insurance companies. You would think “60 Minutes” would be all over it.

Here is a better idea to drive down prices. Remove the patent protection process of trademarked drugs. SIMPLE. No trademark protection or 17 or whatever the hell the years are and all your big pharma companies will be running for the hills. Force the companies to price war against each other just like the generics do when they go through reverse auctions with Mckesson (and no wonder why the one-stop keeps changing). No price monopoly = prices for insurance drops due to lowered reimbursement payouts. It would also cut the crap with all the drug reps annoying the shit out of the pharmacies with their so-called “superior” drugs when they are usually a “me-too” drug but in a dumb package to slip through the FDA.

I am all for obamacare but it won’t address all the buyouts the companies do with the wholesalers and PBM companies.

@noshi- I would have guessed that you were all for obamacare judging by your statement about patents… Did it ever occur to you that one of the main driving forces behind research and development of new drugs is profit. If you eliminate patents, then drug companies (as evil as they are) would not have legitimate incentive to invest millions of dollars in R/D. (And it does cost millions to bring a new drug to market) Drug companies are businesses designed to make money… While this financial motivation may seem misguided (opposed to motivation by compassion for the human race), it has resulted in some serious breakthroughs.

Millions of dollars to bring a new drug to the market? Try BILLIONS. Last I heard, the figure was $500 million to $2 billion, with the average being $800 million.

noshi – as much as I would like to see the patents eliminated, as Aztreonam pointed out, they are an absolute necessity to ensure that the drug companies recoup all the money they spent for the drug’s R&D.

Len, you should just be thankful that there even is a med to help you. Not too long ago it didn’t exist. If you can’t afford insurance or your meds then you should let you presciber know that when writing your scripts. There are usually generic alternatives for most types of drugs which will save you a ton of money. It might be too much to ask that you actually take an active role in your health though right?

Actually, after 24 years of being completely uninsured, with a chronic health condition rendering me near-uninsurable, taking only generics, and the like? Your version of a healthcare plan sounds great! It’s exactly what I already do but at a lower cost to me due to actually having copays for office visits. Another win for the Angry Pharmacist. 🙂

I’m curious, when it comes to the topic of socialized/government run health care, is the reluctance more because the public thinks it will be a raw deal for them based on the facts, or does is trace back to the associations such a system has with the word ‘communism’?

I’m from Australia so we are used to government run systems such as those in the U.K., we get the impression the U.S. has a different stance on the topic, but is that really the public opinion or just those vocal few drawing the somewhat questionable parallels to communism.

Its the working class who forgoes certain luxuries to pay for medical insurance subsidizing those who are less responsible and would rather have a new iPhone with unlimited text messaging vs paying for health insurance. Why punish the people who contribute the most due to the actions of people who choose to contribute the least? Wheres the line between ‘helping those lets fortunate’ and ‘give an inch but take a mile’?

You know what would be better? Nip it in the bud and pass a bill that would outlaw patent protection for all medications. It would get rid of all those pesky drug reps that LOVE to bug you on that Monday morning while you cram for the rush of refill requests. It would tell the government to stop being stupid and pay for expensive brands that are being funded by bribery. Insurance costs would drop as drug prices would drop. Too bad no sane government official that gets cuts from big pharma will ever consider my plan.

The majority of the published information say that the vast majority of the general public do not want a government controlled health care plan. My experience at the pharmacy where I work seems to contradict that information, as the GREAT UNWASHED MASSES really do not care who pays for their meds, just as long as it is not them. TRANSLATION—media information on the health care issue is just HORSESHIT.

We need to somehow eliminate wastage in health care expenses by regulating the abusers and need to cap the CEO’s of health insurance and health care providers.
We need to improve the electronic medical and pharmacy record so we can view when and where the patient was seen and filled the prescriptions and be able to eliminate the duplication of medical service and which diagnostic test and lab were performed.

All hospitals and doctors should follow AMA approved protocol initially to avoid malpractice and save health care expense and malpractice $ should be capped so eliminate the unnecessary lawsuits as attorneys wants retainers for time they have wasted.

There should be a protocol to follow to provide the medical coverage for extreme old and neonates who were born with huge problems due to prematurely born since they will be huge medical liability to future tax payers. Doctors should always provide extreme procedures only if outcome in in favor to recover.

take a look at this article published by Harvard Medicine Titled
‘ Drug Culture ‘ Xanax is still king.. this really puts into prespective about how out of control the doctors and insurance companies have gotten to make a buck..http://aldenclinic.com/xanaxisstillking-a-7.html
Socialize Baby Socialize !!!

Out of control to make a buck ! F@ck you, lady ! I have to hire more and more staff just to sit all day on hold with insurance companies and/or Medicare/Medicaid to try to force them to pay me what they owe me !
The socialized medicine we are getting is gonna kick you in the rear when you find out you have to wait 6 months to get a CT scan and 12 months to see a doctor- if there are any left.

Explain to me how millions of people hooked on Xanax translates to doctors and insurance companies getting “out of control” to make a buck. WTF? How much do you think some of these people pay for the office visit to get their beloved Rx? $0 – none – zilch! They think the withdrawal is bad now, wait until we have Obamacare and they can’t get their freakin’ prescriptions!